Introduction
Meeting the growing demand for registered nurses is an ongoing challenge for nursing programs. The projected shortage of registered nurses is affecting 80% of the states in the United States including the southeastern state used in this doctoral study (HRSA, 2010). Reducing attrition rates from nursing programs will increase the number of graduates and add registered nurses to the workforce. This will have a direct impact on societal needs for registered nurses. The purpose of this study was to determine the associations among length of time between core science course completion and nursing program admission, on-time completion, and NCLEX-RN success for students at a southeastern community college. Although the null hypothesis was rejected for on-time completion, the phi coefficient noted a weak association. The null hypothesis was not rejected for NCLEX-RN success. In addition, the students taking Anatomy and
Physiology while enrolled in the ADN program did not complete the nursing program at a greater than 50% rate.
Based on the results of the completed research, the researcher developed a course titled Academic Student Success for the Nursing Student. The goals of this course is to increase on-time completion and first time passing of the NCLEX-RN examination for the students accepted into a limited admission ADN program.
Description and Goals
Finding ways to increase student completion and success is intuitive to nursing education. Increasing the number of graduating nurses who successfully enter the profession will positively impact the nursing shortage. Section 1 of this study
documented the multiple factors that can affect nursing student success and in turn effect on-time completion and NCLEX-RN pass rates. These factors include academic,
coursework, admission procedures, and student demographics.
The project that resulted from data analysis and evidence from the literature was a one credit hour Academic Student Success for the Nursing Student created to address the academic and coursework factors that potentially could be impeding the success of a nursing student. The course will provide the nursing student with tools to increase their chances of completing the nursing program as well as passing the NCLEX-RN
examination on their first attempt. Curriculum content includes time management, study habits and test taking strategies, knowledge of resources available to them including academic tutoring, and a basic review of Anatomy and Physiology. Many students are not aware of the support services on college campuses available to help them (Markey, 2012). The curriculum content was intended to help the students handle the academic rigor of the nursing program hopefully enhance their chance of success with completing the program as well as passing the NCLEX-RN examination upon completion of the program. Increasing retention is imperative to meet the nursing shortage (Williams, 2010).
This project had several goals to address retention and successful passage of the NCLEX-RN examination on the first attempt. The first goal of this course is to increase on-time completion by 10% the first year after implementation of the Academic Student Success for the Nursing Student. The second goal is to improve first time passing of the NCLEX-RN examination for the students accepted into a limited admission ADN program to greater than 95% for first time test takers. The third goal is to prepare the nursing student for the rigorous nursing program. Fourth goal, it will provide active student engagement strategies to encourage the nursing student to reach their goal of becoming a registered nurse. This in turn will increase the supply of registered nurses.
Rationale
Meeting the increasing demand for registered nursing is a national concern (HRSA, 2010). Nursing programs of all types are faced with identifying strategies to decrease attrition and increase the outflow of nurses who can pass the NCLEX-RN examination and enter the workforce. Attrition affects all types of nursing programs (AACN, 2011; Buchan, 2003; Gilmore, 2008; Porter, 2008). The rationale for the project is to provide tools for student success. Based the data analysis of this study, I concluded that the incoming students are at risk for failure to complete the ADN program on-time. Essentially it is a disservice to not provide them tools to enhance their success.
Integration of strategies for successful completion of the ADN program and NCLEX-RN testing introduced early in the curriculum increases student’s performance (Bonis, Taft & Wendler, 2007; Davenport, 2007). I designed a one credit hour course named Academic
Student Success for the Nursing Student based on the study results and literature review related to curriculum development, student engagement, and retention.
Analysis of quantitative data in Section 2 collected from 288 students identified a statistically significant association for on-time completion and the length of time between completion of core science courses, Anatomy and Physiology, prior to admission to an ADN program. Although a statistically significant association was noted, the phi
coefficient showed a weak association for on-time completion. When looking at the data, the majority of the nursing students (59.4%) had taken their Anatomy and Physiology course within 3 years of entering the program. The second highest percentage (35.1%) had taken the course while enrolled in the nursing courses their first and second semester in the ADN program. Of those students, greater than 50% do not complete the nursing program on time. Taking Anatomy and Physiology while in the nursing programs added six additional contact hours to the 19 required contact hours for nursing courses in the first semester of the program. The time frame for completion of Anatomy and Physiology prior to entering the ADN program is presented in Table 5.
Table 5
2007-2012 Cohort Anatomy and Physiology Completion Time Time Frame Frequency Percent
0-36 Months 171 59.4
37-60 Months 11 3.8
61-120 Months 5 1.7
Took in Program 101 35.1
The Academic Student Success for the Nursing Student was developed to provide tools and strategies for those students already admitted to the nursing program to enhance their successful completion of the program and preparation for the NCLEX-RN
examination. The content of the course will include: identifying campus resources, study habits, test taking strategies including NCLEX-RN style test question, time management strategies, critical thinking, simulation orientation, and basic review of Anatomy and Physiology. The curriculum content was intended to help the students handle the academic rigor of the nursing program.
Review of the Literature
The literature review in Section 1 focused on Theoretical Framework, On-Time Completion, NCLEX-RN, and Success Variables. This literature review focused on research to support curriculum development and expanded on retaining and engaging a nursing student which is an essential part of the project. The evidence from the literature guided the development of the project. The following databases were used: Cumulative Index to Nursing & Allied Health Literature, Education Research Complete, Education Resources Information Center, Google Scholar, Sage, and Proquest Dissertation and Thesis Database. The following keywords were used in the search: Andragogy, attrition, constructivism, curriculum development, curriculum evaluation, nursing student attrition, scaffolding of learning, student engagement, student success, persistence, predicting success, and retention. The literature review is divided into three sections including
Curriculum Development, Student Engagement, and Retention which supports the development of the project.
The theoretical framework for this project will be guided by Knowles’s (1984) Andragogy and scaffolding of learning, which is founded in constructivism (Heroff, 2009; Knowles, Holton, & Swanson, 2012; Merriam, Caffarella, & Baumgartner, 2007). Knowles’s andragogy is based on several assumptions regarding the adult learner:
1. Need to know 2. Self concept
3. Adult learner experiences 4. Readiness to learn
5. Orientation to learning 6. Motivation to learn
Understanding how and what motivates an adult to learn is an important consideration in developing curricula and learning activities. Scaffolding the learning process to incorporate previously learned concepts that will assist the learner to retain and apply information is a process that is imperative in nursing education (Heroff, 2009; Knowles, Holton, & Swanson, 2012; Merriam, et al., 2007). The Academic Student Success for the Nursing Student course will incorporate this scaffolding process and provide the learner with motivation and ownership of the process (Knowles et al., 2012).
Academic success is required to achieve successful outcomes for stakeholders. Facilitating academic success begins with curriculum development. Curriculum must be presented in a way that engages students and provides them with tools to utilize to support their educational endeavors. Due to the statistically significant results of this study, Academic Student Success for the Nursing Student was created to provide strategies for success in a rigorous program, achieve on-time completion, and to assist students to pass the NCLEX-RN on first attempt. Many programs have implemented seminars to acclimate nursing students to the rigor of nursing school and to address what students should expect (Mennenga & Tschetter, 2012; Harding, 2012; Upcraft, Gardner, & Barefoot, 2005).
Students have a preconceived notion of nursing school. Once students enter the program, they may be overwhelmed by the demands and expectations, as well as the instructional strategies. Elder (2015) discussed the use of problem based learning (PBL) as an active engagement strategy which is consistent with the use of simulation in the nursing program. There are many benefits to PBL such as the importance placed on students’ reflection and self-directed ability to learn, increased levels of engagement, study effort, and concentration (Wijnia, Loyens, & Derous, 2011). The criticism
surrounding PBL involves the difficulty associated with novice learners including lack of knowledge and inability to determine or judge what information is pertinent to the
situation. Phillips et al. (2013) discussed the complexities involved with developing innovative nursing curricula. The researchers indicated that allowing students to actively
engage in their learning will increase their learning accountability and may lead them to be more skilled in meeting the complex demands of the health care system.
Fahey (2012) discussed the challenges that face institutions of higher education, including the importance of multidisciplinary thinking to prepare future leaders. Critical thinking is required in nursing and the management of patients’ care. The case study Fahey performed addressed curricula revisions with ongoing evaluation and alignment with internal goals and external directives (Fahey, 2012). The nursing profession uses an interdisciplinary approach to patient care and continuous evaluation. Nurse educators participate in ongoing curriculum evaluation, as do nursing students. Nduna (2012) analyzed evaluation reports and found in some programs there was no preparatory stage to introduce students. The clinical component or workplace learning can be an eye- opening and stressful experience for nursing students. Aligning the expectations of the workplace with academic learning will assist in preparing the students to use critical thinking and time management skills (Nduna, 2012). The course developed for nursing students’ success aligns clinical and simulation lab expectations for the student. This decreases the students’ anxiety related the clinical and laboratory components of the ADN program.
Engagement
Student engagement is a concept addressed in the literature and is integral to this project.Student engagement is a complex topic that incorporates many facets of learning that contributes to student success that include behavioral, psychological, socio-cultural,
and holistic perspectives (Kahu, 2013). Associate degree nursing programs incorporate a broad range of students, ranging from the traditional 18-year old through the 45- or 50- year old non-traditional student. In light of the technology that students have access to and use on a daily basis, it is essential for nurse educators to keep up to date the newest technologies and to be aware of the broad age groups and learning styles that are evident in the group. Hodge (2014) discussed various approaches to learning that may lead to a lasting change in a student’s academic behavior. Study skills programs, coaching, and adventure education were explored and the researcher found that a combination of these approaches may lead to a substantial shift in behavior. Applying this information to the nursing student success course, it is important to consider the change in behavior that must occur. Instead of using memorization to study for a test, students in the nursing program must apply, analyze, evaluate, and synthesize patient information to make decisions. In addition, the information learned in nursing builds or scaffolds, and students must retain information and pull the concepts learned forward. Incorporation of study, test-taking and time management skills into the nursing student success course will provide positive direction for the students. Hodge indicated that learning new skills is more difficult and takes considerable effort. Both Hodge (2014) and Kahu (2013) offered insights into the complexities of student engagement and behaviors that can be applied in the Academic Student Success for the Nursing Student course.
There is research supporting the use of online tools to promote student
et al., 2012; McKenzie, 2014; Wang, 2013). Abdelaziz, Kamel, Karam, and
Abdelrahman (2011) evaluated e-learning versus traditional lecture for undergraduate nursing students and recommended a blended or hybrid environment for the most efficient and effective method of instruction. Johnson and Palmer (2015) investigated student perceptions of online and face-to-face versions of an introductory linguistics course. The data from five semesters show students enrolled in face-to-face courses had GPAs that were 0.312 points higher than those of their peers in online courses. In this particular study, students who were more likely to succeed are more likely to enroll in face-to-face courses. Although this is one study promoting the use of a face-to-face course, it is expected that face-to-face contact will promote student engagement within the nursing program.
Retention
Based on the data analysis, retention in this ADN program is an issue.Admission into the ADN program is based upon selective admission criteria. The assumption is that students who are admitted are equipped for success in the nursing program, yet the aggregated on-time completion rate is 66.2%. Nationwide nursing program struggling with low retention rates and are developing numerous retention related interventions to address the problem (McDonough, 2012). McDonough (2012) found that nursing
programs that develop and implement retention related program had a positive impact on retention rates.
Mennenga and Tschetter (2013) implemented a first-year seminar to introduce nursing. Students became aware of the high expectations and requirements for success early in their academic career, which lead to choosing alternate career paths in some cases. Fontaine (2014) evaluated the effects of a retention program using seven different retention strategies. The correlational analyses showed a statistically significant
improvement in retention (p = 0.048), but no correlation with any specific strategy or combination of strategies (p. 98).
Implementation
The course entitled Academic Student Success for the Nursing Student was developed to help students learn tools and strategies to increase their chance of success in their nursing educational pursuit. This one credit hours course is designed to address campus resources, study skills, test taking strategies, critical thinking, time management, simulation orientation, and Anatomy and Physiology overview. Best practices in
education will be utilized during the development phase.
This course will be offered the fall semester of each academic year. All newly accepted nursing students will take the course the fall semester of their freshman year in the nursing program. The course will be offered the first nine weeks of a 16-week semester. It will be taught in conjunction with the other nursing education and general education courses in the degree plan for the nursing program. All incoming, newly accepted students will be required to take the course. The course will be taught in a traditional classroom setting to foster student engagement and participation.
The researcher will seek approval for the implementation of the course from the nursing department chair and college’s curriculum committee. The college’s curriculum committee consists of the Vice President for Academic and Student Services, Associate Vice President of Academic and Student Services; Director of Admissions and Records or designee; Director of College Transfer Advising Center; Director of Financial Aid; Academic Division Chairs; Director of Library Services or designee; Distance Education Coordinator; Coordinator, High School Cooperative Programs; and the Director of Planning and Research, and at least one faculty representative from all academic divisions.
Once the Academic Student Success for the Nursing Student course is approved implementation will begin the following fall semester. The content of the course will include: identifying campus resources, study habits, test taking strategies including NCLEX-RN style test question, time management strategies, critical thinking, simulation orientation, and basic review of Anatomy and Physiology. The content of the course will be shared with the faculty in the ADN. Input from the nursing faculty will be sought to ensure the course is providing the students the tools needed to be successful in their educational endeavors.
Potential Resources and Existing Supports
Potential resources for this project and existing supports are the Vice President of Academic and Student services, the Nursing Department Chair, and the nursing faculty. The southeastern college used for this study has a college-wide goal to improve student
success and completion rate. The college wants to increase the number of students ready to enter the workforce with job-ready credentials. With this goal in mind, resources for this project are readily available on campus including the Office of Institutional Effective and Innovation and the Academic Skills Center. As stakeholders vested in the success of their students, the nursing faculty have a commitment in their students’ overall success in the program and NCLEX-RN examination results. As part of the nursing faculty, I will be able to develop and teach the course. Feedback to the nursing faculty strategies
implemented in the course can be provided through monthly faculty meetings.
Potential Barriers
Due to the content of the course being specific to nursing students, the course will be taught by nursing faculty. Previously, the college student success course could be taught by any faculty member on campus regardless of their teaching discipline. Some nursing faculty may be resistant to this change as well as the increase in teaching hours the first semester of the nursing curriculum. Modification to an existing course will require faculty preparation time and acquisition of knowledge to teach the course. Faculty will need to become comfortable with the course content to teach the content. Students may complain about being required to complete the course in their first semester of the ADN program. Despite these potential barriers, the Academic Student Success for the Nursing Student course is designed to present tools that will assist the nursing student in completing the program and passing the NCLEX-RN examination to be able to practice as a registered nurse.
Proposal for Implementation and Timetable
I propose to get college approval for the Academic Student Success for the Nursing Student course in fall 2015. The course will be presented to the college-wide